Abstract
Orthodontic problems peculiar to the cleft palate patients, as pointed out so often, could be summarized collectively as follows; the gnathic deformity of the maxilla due to the lack of growth, maxillary segmental collapses, morphological as well as positional abnormalities of the individual teeth and the mandible. These dental irregularities are almost due to lingual bending of the alveolar bone more than the growth retardation, the condition of which is responsitive to the orthodontic treatment to a considerable extent. The position of the mandible, also, with the difference in size between individuals, seems to have an indirect influence from the maxilla through muscular function. To the contrary, the maxillary complex is deficient in itself, playing a leading role in all accompanying cleft disturbances. Accordingly, the most critical point in the orthodontic treatment is whether it is possible to accelerate the maxillary growth to its full potential. With regard to this important concern, maxillary expansion has ever been tried with a hope that it might give favorable effects on maxillary growth not only laterally but also in a forward direction. To be regretful, it has been nullified scientifically with abundant evidence that the orthodontic treatment would affect very little or nearly nothing. Relieved to indicate the effect of maxillary protraction introduced in the early 80's it must not be exaggerated only for the Japanese who are characterized with flat faces deficient in growth in depth with our arms spread out.
Then, it is quite natural for orthodontists to be obliged to focuss their efforts on growth control of the mandible by a lengthy application of chin cup to adjust it to the retarded maxilla. However, now this orthodontic approach has been criticized by many orthodontists because of an evaluation weighing with an excessive loading for the patient and his/her family to the treatment result which could be earned exclusively by a incomparably prolonged period of treatment for no less than ten years. As a matter of course it tends to procrastinate its start with more possibility of maxillofacial surgery for advancement of the maxilla.
It is absolutely tr ue that present surgical management of cleft children has various unfavorable effects on their maxillary growth more or less. The controversy could be summed up to two points practically; one is surgical method, and the other is timing. Moreover, particular is the trade-off in nature between speech and growth. It is thought like a seesaw. Most surgeons would agree to put more importance on improvement in speech in compliance with a speech therapist. Under these circumstances it is hard for orthodontists to expect to have their cleft patients' jaw grow well.
